HomeMy WebLinkAbout1793~15~;~9
n• isn MICNAN~Cf RAMCO FORM 120'•,
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Betore me. the undersigned autho~ity, pe-sonelly appeared
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who, being duly sworn, says tha e is the lie~o~ herein or the age~t of tha lienor herein, _
and that in pursuance of a cont~act with ~aJ~y~,aZy .
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lienor furnished labo~, services or materials consisting of: (Oescribe specially fabricated materials separat~ly~.
a "~~,~-. ~~~ u~ ~
CG~i~~s~ ~.c~.l~~~^-
(Lienor's Name)
whose address is .. ~U 0~Q'-~~.ll~~ ~ ~'~. ~~ ~ 7
(lienor's Address) .
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on the tollowing described real property in .. 1~: 'S .~~. . `.- County, Florida:
(Describe real property sufficiently ior iden ' ication, includiR~ street and number, ii known)
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owned by `~ • .
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' /`~e _ . ~ tjti
of a total value ot ~^"-~- ~~~ ~/(,t, i dollars SS .~~ S -
_ _ _ _. 1
of which there remains unpaid S , tor which amount he claims a lien on the above
described real property.
He further says that lienor /urnished the tirst of said labor, services o~ materials on ~`~,., ~~
. 19 ~ V and the last of the same on . ~~'~C.'. y~ , 79 C~;~and (it the tien
is claimed by one not in privity with the owner) that the lienor served his notice to owne- on ~ Gii,~, rG ~~
.19G ~.by _
' " (Method of Service) .
and. (ii the lien is claimed by one not in privity with the contractor) that the lienor served a copy ot his notice to
owner on
(ContraCtot)
on .19 .by
(Method of Service) •
and additionally, (ii the tien is claimed by one not in privity with the subcontracto~) that the lienor served a copy
oi his notice to owner on
on ~1aJl~il~ 19
198! J:'; 29 ~; '2. ~~
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Swo~n to and subscribed before me this o~ ~.
llli• ~i-•Irr~-rr~~nl j-r~yini.•rl I-~ -
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(Subcontractor-
. by
_ . ~i
1Method ot Service)
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